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Final Year Defintions > Urology & Renal Medicine > Flashcards

Urology & Renal Medicine Flashcards

1
Q

Acute Urinary retention

A

sudden, painful inability to pass urine. Urological emergency

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2
Q

Which surgical procedures are most likely to cause urinary retention?

A

NOF repair / hip replacement
Pelvic surgeries
Hernia repairs

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3
Q

Macroscopic haematuria

A

visible blood in the urine

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4
Q

Causes of painLESS haematuria

A

Malignancy

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5
Q

Causes of painFULL haematuria

A

Malignancy
Infection
Stones
Trauma

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6
Q

Malignancies that can cause macroscopic haematuria

A

renal tract, gynaecological, prostate, colon - enterovesicle fistula

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7
Q

Most common benign tumour which can cause macroscopic haematuria

A

Angiomyolipoma (AMA)

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8
Q

Causes of acute scrotal pain +/- swelling

A

torsion, epididymitis, orchitis, appendix testis torsion, testicular mass, hydrocele, spermatocele, varicocele, testicular rupture

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9
Q

Differentials for loin pain

A

urolithiasis (stones - ureteric or renal colic), pyelonephritis, constipation, gynaecological, malignancy, MSK, traumatic

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10
Q

Acceptable urine output

A

0.5 ml per kg per hour - works out to 30 ml per hour in a 70kg person

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11
Q

What are the functions of the kidney? (Think: ABC)

A
  • A - acid, anaemia
  • B - bones (vitamin D)
  • C - clearance
  • D - drugs
  • E - electrolytes, eating (dietary restrictions in renal failure)
  • F - fluid (therefore BP)
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12
Q

What three things must be included in MDRD calculations which can affect the result?

A

age, gender, ethnicity

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13
Q

What is EDTA eGFR and when is it used?

A

measure of kidney function independent of creatinine and urea levels (because these two values can be deranged by various other pathologies)

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14
Q

Which patient populations have naturally higher levels of creatinine production?

A 
young
males
high muscle mass
heavier mass
ethnicity (black)
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15
Q

How might a patient in renal failure present? (HINT: think of the functions of the kidneys)

A 
Low eGFR therefore high creatinine 
Anaemia - treated with EPO and iron 
Deranged electrolytes - esp potassium 
Acidosis 
Renal osteodystropy and secondary hypoparathyroidsm - due to problems with vitamin D metabolism.
May have low urine output
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16
Q

Name a type of classification for acute renal failure and briefly describe each one

A

Pre renal - decreased perfusion

Renal - intrinsic kidney injury

Post renal - obstruction

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17
Q

List some of the causes of pre renal renal failure

A

Shock:

  • cardiogenic
  • hypovolaemic
  • septic
  • anaphylactic
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18
Q

Name some of the causes of renal renal failure

A 
Glomerulonephritis (eg autoimmune)
Infection - pyelonephritis 
Nephrotoxic agents (eg gentamicin)
Trauma 
Acute tubular necrosis 
Malignancy
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19
Q

Name some of the causes of post renal renal failure

A

Renal calculus
Bladder malignancy
Stricture
BPH / Prostate cancer

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20
Q

Describe the assessment of a patient in AKI

A

Full history and examination (should have occurred as bloods will be what highlights AKI)
Fluid assessment - will help determine cause if pre renal failure
Urinalysis - useful for all types, especially in determining between nephrotic and nephritic syndromes
USS - will help location obstruction in post renal failure

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21
Q

What is the management of pre renal renal failure?

A

Determine fluid status -

  • If overloaded = diuretics
  • If dry = fluids
22
Q

What is the management of post renal renal failure?

A

Catheter

Nephrostomy

23
Q

Why is renal transplant the best treatment for renal failure?

A

Transplant has the best prognosis and quality of life of all RRT - it is also very cost effective (especially compared to dialysis)

24
Q

What are the three major causes of post transplant mortality (usually in the first three months)?

A

Infection - fatal due to immunosuppression

Cardiovascular disease (stroke and MI) - multifactorial: pre operative cardiac risk factors (CKD, T2DM, HTN) but also immunosuppression adds further risk

Malignancy - particularly lymphoma and skin (again due to immunosuppression)

25
Q

What are the renal causes for acute allograft dysfunction? (HINT: think RING)

A

Rejection
Infection
Nephrotoxic agents (esp NSAIDS and calcineurin inhibitors)
Glomerulonephritis (esp autoimmune)

26
Q

What is an important blood test if there are concerns about acut rejection?

A

DSA - donor specific antigens

27
Q

Which drugs can cause AKI? (HINT: think CANDA)

A 
Contrast
Aminoglycosides (gentamicin)
NSAIDS
Diuretics
ACEi
28
Q

Outline the presentation of chronic renal failure

A 
Uraemia 
Sodium retention
Protein loss
Acidosis
Hyperkalaemia
Anaemia 
Vit D deficiency
29
Q

List some of the risk factors for AKI

A 
CDK
Drugs
Age
Sepsis
Dehydration
Organ failure
30
Q

Name some drugs that can cause AKI

A 
Diuretics
Tacrolismus
ACEi
NSAIDs
Aminoglycosides (eg: gentamycin)
Methotrexate
Contrast
Chemotherapy
31
Q

List the causes of post-renal AKI (HINT: think SNIPPIN)

A 
Stone
Neoplasm
Infection
Prostatic hypertrophy
Posterior urethral valves
Inflammatory
Neurological
32
Q

What are the indications for dialysis in AKI? (HINT: think AEIOU)

A 
Acidosis
Electrolytes (refractory hyperkalaemia)
Intoxications - drugs that can be removed by dialysis (eg: salicylates)
Overload
Uraemia
33
Q

List some complications of chronic renal disease

A 
Cardiovascular disease 
Renal osteodystrophy
Fluid overload / oedema 
Hypertension
Electrolyte disturbances 
Anaemia
Let restlessness
Sensory neuropathy
34
Q

How would a patient in chronic renal failure present?

A

Low eGFR therefore high creatinine

Anaemia - treated with EPO and iron

Deranged electrolytes - esp potassium

Acidosis

Renal osteodystropy and secondary hypoparathyroidsm

May have low urine output

35
Q

At what stage of CKD do symptoms usually appear?

A

Stage 3 - when GFR falls below 40

36
Q

List the features of polycystic kidney disease in adults (HINT: think MISSHAPES)

A 
Mass - abdominal mass +/- pain
Infection 
Stones
Systolic hypertension 
Haematuria 
Aneurysms - berry aneurysms —> SAH
Polyuria + nocturia 
Extra-renal cysts - usually hepatic 
Systolic murmur - mitral valve prolapse
37
Q

Define: pis-en-deux

A

Urinary urgency shortly after voiding

38
Q

Define: strangury

A

Severe pain and a strong desire to urinate

39
Q

List some causes of urinary tract obstruction (HINT: split into - luminal, mural and extramural)

A

Luminal - stones, clots

Mural - strictures, tumour

Extra-mural - prostatic enlargement, pelvic tumour

40
Q

List LUTS (lower urinary tract symptoms) in males

A 
Frequency
Hesitancy
Poor stream
Terminal dribbling
Overflow incontinence
41
Q

How can LUTS (lower urinary tract symptoms) in males be classified?

A

Filling (storage) / Irritative symptoms

Voiding / Obstructive symptoms

42
Q

List the cardinal filling (irritative) urinary symptoms in men

A

Frequency
Urgency
Dysuria (painful urination)
Nocturia (excessive urination at night)

43
Q

List the voiding (obstructive) urinary symptoms in men

A 
Poor stream 
Hesitancy
Terminal dribbling
Incomplete voiding
Urinary retention
Overflow incontinence
44
Q

List some causes of urinary retention (HINT: split into obstructive, neurological and myogenic)

A

OBSTRUCTIVE -

  • Mechanical: BPH, stricture, stones, constipation
  • Dynamic: drugs

NEUROLOGICAL - pelvic surgery, MS, DM, spinal injury

MYOGENIC - EtOH

45
Q

Name and describe the two classifications of chronic urinary retention

A

High pressure - high detrusor pressure at the end of micturition due to bladder outflow obstruction

Low pressure - low detrusor pressure at the end of micturition

46
Q

How do you manage low pressure chronic urinary retention?

A

TURP

47
Q

How do you manage high pressure chronic urinary retention?

A

Catheter

48
Q

What are the three most common sites for urinary tract calculi?

A

PUJ (pelvic-ureteric junction)
Pelvic brim (where the iliac vessels cross the ureters)
VUJ (veso-ureteric junction)

49
Q

What is the most common type of renal calculi?

A

Calcium oxalate

50
Q

List some drugs associated with renal calculi

A

Loop diuretics, thiazides, antacids, steroids, theophylline, salicylate

51
Q

List some of the complications associated with a TURP (HINT: think: immediate, early, late)

A

IMMEDIATE - haemorrhage

EARLY - infection, clot retention

LATE - retrograde ejaculation, ED, incontinence, urethral structure, BPH recurrence

52
Q

How do you differentiate between BPH and Prostate Ca on PR?

A

BPH - smooth bilateral enlargement of prostate (therefore median sulcus is definable)

Ca - “craggy”, hard, irregular unilateral enlargement of prostate (therefore median sulcus is lost)

Final Year Defintions (13 decks)

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